A client who underwent abdominal surgery 12 hours ago is complaining of increasing pain at the incision site and reports feeling nauseated. During your assessment, you note the incision site appears red and swollen with a small amount of cloudy drainage. What is the most effective nursing intervention to address the situation and reduce the likelihood of complications?
Document the client’s complaints, findings, and actions in the medical record.
Administer pain medication as prescribed to manage the client’s discomfort.
Apply a warm, moist compress to the incision site to reduce inflammation.
Notify the healthcare provider about the client’s symptoms and findings.
The correct answer involves notifying the healthcare provider promptly as these symptoms suggest that the client may be developing an infection or other complication requiring medical evaluation. Infection can lead to further complications if not treated early. Administering pain medication without addressing the underlying issue delays appropriate treatment and overlooks the potential infection. Documenting the findings is important but alone does not address the client’s safety. Applying a warm, moist compress without consultation may worsen the condition if the wound has an infection, especially without confirming the appropriate action with the healthcare provider. Monitoring for signs of systemic infection like fever or increased heart rate is also critical at this stage.
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What are the signs and symptoms of a surgical site infection (SSI)?
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NCLEX RN
Physiological Integrity
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